Maternal near miss in a tertiary care hospital A Cross Sectional study

Abstract

Title: Maternal near miss in a tertiary care hospital: a cross sectional study. Objectives Primary Objective: To determine the prevalence of maternal near miss due to obstetric complications or maternal disease in a tertiary hospital.Secondary Objective: To determine severe maternal outcome ratio(SMOR), maternal near miss ratio(MNM ratio) and maternal near miss mortality ratio Materials and methods: A cross-sectional study was conducted in KLES Dr.Prabhakar Kore Hospital and MRC, tertiary care hospital, Belagavi From January 2015 to December 2015, all consecutive cases of maternal near miss (MNM) and maternal death (MD) were included. WHO near miss criteria was considered as standard to include patients for the study Results: There were 6275 deliveries during the study period of which 6077 were live births, 97 cases were included in the study who fulfilled the WHO near miss criteria. 84 patients of the study population were maternal near-miss cases and 13 were maternal deaths. The mean age among the study group was 21-25 years, Majority of the population were primigravida with term gestation and were unregistered. The statistical analysis of demographic profile showed no significance in the categories of age, parity, and occupation whereas, gestational age, antenatal care and mode of termination of pregnancy in the study population showed statistical significance. The commonest causes of morbidity among the maternal near miss group were Anemia, hemorrhage and hypertensive disorders, accounting for 44%, 45% and 50% respectively. In the maternal death group it was anemia 69%, hemorrhage 61%, other conditions 46% and infections 15%. Infections and other conditions as a cause were statistically significant. In MD group 46% died with in 24 hours of admission and 53% died after 24 hours of admission. In MNM group 38% had received massive blood transfusion, 13% underwent emergency obstetric hysterectomy, and 16% required ventilator support. Prevalence of MNM was 1.3% near miss incidence is found to be 13.3 per 1000 live births and maternal mortality rate is 213 per 100000 live births. The MNM to MD was 6:1. The maternal mortality index (MI) in this study is 13%. Conclusion: The near miss incidence in our hospital is 13.3 per 1000 live births and maternal mortality rate is 213 per 100000 live births, which suggests the quality of health and care provided. Registered cases who took regular antenatal visits resulted in maternal near miss and no maternal deaths. Early evaluation and treating the morbidity at its root does prevent maternal death. Timely and prompt referral of high-risk cases to tertiary care centers goes a long way in reducing maternal and perinatal morbidity and mortality. Thus Evaluation of the circumstances surrounding near miss cases could act as proxy for maternal deaths which can be prevented.